TREATMENT OF HEART FAILURE PATIENTS IN UNIVERSITY AND GENERAL HOSPITAL IN 1997
Abstract
Background. Chronic heart failure is a serious condition with high morbidity and mortality. Prognosis can be improved with early diagnosis and adequate nonpharmacologic and pharmacologic treatment.
Aims of the study. Aim of the study was a comparison of diagnostic and therapeutic management of patients who were hospitalized in the University or Community hospital.
Methods. The hospital records of patients, hospitalized for heart failure, from University hospital (UH, Internal clinic, Department of angiology, Department of hypertension) and Community hospital (CH, Department of Internal medicine) were reviewed retrospectively. We included all consecutive patients in the period from January 1, 1997 to June 30, 1997 (CH) and December 31, 1997 (UH) who were discharged or died with diagnosis of a heart failure.
Results. Six hundred and twenty-five patients (307 from CH and 318 from UH), aged 76 ± 11 years, were included in the survey. In 308 (49%) patients heart failure was diagnosed prior to index hospitalization. Rehospitalization rate was 42%. Etiology of heart failure was ischemic heart disease (36%), arterial hypertension (37%), dilated cardiomyopathy (16%) and valvular heart disease (15%). The hospital stay was 14 ± 10 days in UH and 10 ± 6 days in CH (p < 0.001). Overall in-hospital mortality reached 16% (98 patients) and was 8% in UH and 24% in CH (< 0.001). Echocardiography was performed in UH in 45% and in CH in 13% of all patients and in 50% vs. 22% of patients, hospitalized for the first time. At the discharge the following drugs were prescribed (UH vs. CH): diuretics (82% vs. 73%), ACE inhibitors (61% vs. 33%), digoxin (54% vs. 71%) beta-adrenergic blockers (3% vs. 0%) and antiarrhytmics (7% vs. 32%). Among the patients with systolic dysfunction 69% from UH and 32% of patients from CH received ACE inhibitors. In patients with atrial fibrillation, warfarin was prescribed to 34% and 5% UH and CH patients, respectively. The advice regarding lifestyle changes in discharge records was found in only 21% and 3% from UH and CH patients.
Conclusions. Our survey showed a considerable gap between guidelines and clinical practice in hospital management of patients with heart failure. This gap is more evident in CH. Most prominent features are underuse of echocardiography in diagnostic algorhytm, underuse of ACE inhibitors in treatment of systolic dysfunction, non-use of beta-adrenergic blockers and unsufficient nonpharmacologic advices in discharge records.
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